Despite opposition from one of its affiliates, an influential union
representing physicians is pushing adoption of a psychologist-prescribing
bill. Talks are planned to try to resolve the standoff.
For the first time, the California chapter of the Service Employees
International Union (SEIU), which represents 600,000 workers in the state,
threw its considerable weight behind a state bill (SB 993) that would allow
psychologists to prescribe psychotropic medications, as well as medications to
treat the side effects of those psychoactive drugs.
The bill is a much more wide-ranging approach to expanding psychologists'
scope of practice than any of the several previous bills the state legislature
has faced over the last dozen years. The California Senate's Committee on
Business, Professions, and Economic Development voted in April to stop a
prescribing bill for this year (Psychiatric News, August 17), but
that reprieve is expected to be only temporary because of powerful allies
psychologist-prescribing advocates gained this year. Among these new
supporters is the American Federation of State, County, and Municipal
The union-based effort in support of the legislative agenda of the
California Psychological Association and the National Alliance of Professional
Psychology Providers came without the knowledge or backing of a California
physicians union that is part of SEIU.
"We are not supporting it," a senior official with the
Committee of Interns and Residents (CIR), who asked not to be identified, said
about the prescribing bill in an interview with Psychiatric News.
The CIR, which has been affiliated with the 1.6 million-member SEIU since
May 1997, has begun discussions with the parent union regarding its support
for the psychologist-prescribing bill. The CIR, which represents more than
12,000 house-staff physicians in California, Florida, Massachusetts, New York,
New Jersey, Washington, D.C., and Puerto Rico, has about 2,500 members in
The CIR official would not comment on what outcome was expected from the
discussions and downplayed the level of conflict, saying, "This is not
an adversarial situation."
Representatives at the national office of SEIU and the SEIU California
State Council—which is supporting the prescribing bill—did not
return calls from Psychiatric News for comment by press time.
The unions became involved in the California legislative campaign to allow
psychologist prescribing as part of a membership strategy to recruit
psychologists who work in state hospitals and prisons, according to Randall
Hagar, director of government affairs for the California Psychiatric
The SEIU California State Council lists the bill on its Web site as one it
is sponsoring. The SEIU, Hagar said, has made the bill a leading legislative
priority and plans to earmark a substantial portion of a $50 million political
war chest the council has set aside for "health issues"
The bill is needed, according to a statement by the California
Psychological Association, because of the "lack of access to affordable
psychiatric services in the community and the deterioration of services in
California's state hospitals and prison system."
The bill's training and scope-of-practice authority, Hagar said, would
likely allow psychologists to function as mental health patients' primary care
providers with authority to commit them and to order restraints.
Abigail Donovan, M.D., APA's member-in-training trustee, said that
psychiatrists in training are uniquely positioned to join the fight against
psychologist-prescribing privileges because they fully understand the
extensive training, both didactic and clinical, that is needed to prescribe
psychiatric medications in a safe and effective manner.
"This is training that psychologists simply don't have and can't get
through a limited 'prescribing' curriculum," Donovan said. "As
doctors, we are dedicated to the health and well-being of our patients;
psychologists' prescribing psychiatric medication is not only bad medicine,
but it is also potentially detrimental to the health of our
She encouraged members of CIR to tell their union leadership that they
oppose remaining affiliated with a union that supports
psychologist-prescribing privileges. CIR's psychiatrist members could also
contact their APA district branch for additional support, Donovan suggested,
and other physicians could contact their local specialty society or medical
The presence of unions in the prescribing fight will require a new strategy
to neutralize their impact in a legislature where they wield tremendous
influence, Hagar said. The timing on that strategy is limited because the
bill, defeated in committee, is allowed to return in 2008, during the second
half of California's two-year legislative session.
Previous efforts over the last 12 years to pass a psychologist-prescribing
bill in California have rarely moved out of committee; however, a 2000 measure
was approved by the state Assembly.